Millan Braden, Cassim Raees, Uy Michael, Bay Benjamin, Shayegan Bobby
Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Can Urol Assoc J. 2023 Feb;17(2):39-43. doi: 10.5489/cuaj.7914.
We aimed to evaluate the feasibility and safety of implementing a sameday discharge (SD ) protocol for robot-assisted radical prostatectomy (RARP) and pelvic lymph node dissection.
We performed a prospective cohort study including all consecutive eligible patients undergoing RARP in 2021 following initiation of SDD RARP protocol in April. Baseline characteristics were compared using t-tests, Mann-Whitney U tests, and odds ratios (OR ) calculated using multiple logistic regression to assess for predictors of SD success.
A total of 117 patients underwent RARP in 2021 following initiation of the SDD protocol. Fifty-seven patients were initiated on the SD pathway and 60 patients underwent surgery as an inpatient (IP-RARP). Of those on the SD pathway (SD-RARP), 33 (58%) were successfully discharged the same day of surgery, while 24 (42%) failed SD . Baseline demographics were well-balanced between cohorts. Case order, increased patient age, and distance travelled to the hospital were factors associated with selection of patients for the IP-RARP protocol. In total, 12 SD and 12 IP patients presented to the emergency department (p=1.0), and none within 24 hours of discharge. There were no hospital admissions in the SD cohort, with four readmissions in the IP cohort (p=0.1). Multiple logistic regression revealed that case order (first case) was the only predictive factor for SD success (OR 4.08, 95% confidence interval 1.59-11.62, p=0.005).
Implementation of an SD pathway following RARP is feasible, with no increase in rates of complications, unscheduled visits, or readmissions.
我们旨在评估对机器人辅助根治性前列腺切除术（RARP）和盆腔淋巴结清扫术实施同日出院（SD）方案的可行性和安全性。
我们进行了一项前瞻性队列研究，纳入了自4月启动同日出院RARP方案后在2021年连续接受RARP的所有符合条件的患者。使用t检验、曼-惠特尼U检验比较基线特征，并使用多因素逻辑回归计算优势比（OR）以评估同日出院成功的预测因素。
在2021年启动同日出院方案后，共有117例患者接受了RARP。57例患者采用同日出院路径，60例患者作为住院患者接受手术（住院RARP）。在同日出院路径（SD-RARP）的患者中，33例（58%）在手术当天成功出院，而24例（42%）同日出院失败。各队列之间的基线人口统计学特征均衡。病例顺序、患者年龄增加以及到医院的距离是与选择住院RARP方案患者相关的因素。总共有12例同日出院患者和12例住院患者前往急诊科就诊（p = 1.0），出院后24小时内均无此类情况。同日出院队列中无再次入院情况，住院队列中有4例再次入院（p = 0.1）。多因素逻辑回归显示，病例顺序（首例病例）是同日出院成功的唯一预测因素（OR 4.08，95%置信区间1.59 - 11.62，p = 0.005）。
RARP后实施同日出院路径是可行的，并发症发生率、非计划就诊率或再次入院率均未增加。
